Kevin P Collins1, David A Geller1, Michael Antoni2, Drew Michael Donnell3, Allan Tsung1, James W Marsh1, Lora Burke4, Frank Penedo5, Lauren Terhorst6, Thomas W Kamarck7, Anna Greene1, Daniel J Buysse8, Jennifer L Steel9. 1. Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA. 2. Department of Psychology, University of Miami, Miami, FL, USA. 3. Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA, USA. 4. School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA. 5. Department of Medical Social Sciences, Psychology, and Psychiatry and Behavioral Sciences, Northwestern University, Evanston, IL, USA. 6. Department of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA. 7. Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA. 8. Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA. 9. Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: steeljl@upmc.edu.
Abstract
OBJECTIVE: Sleep problems have been linked to increased risk of mortality in the general population. Limited evidence suggests similar relationships among people diagnosed with cancer. The aims of the present study were to investigate the type and rates of sleep problems in advanced cancer patients and examine whether sleep problems are associated with survival. METHODS: A prospective study of 292 patients with advanced cancers affecting the hepatobiliary and pancreatic systems were administered a battery of questionnaires measuring sociodemographic information, sleep, and depression. Descriptive statistics, ANOVA, Chi-square, Kaplan-Meier survival, and Cox regression analyses were performed to test the aims. RESULTS: The majority of patients were male (64%) and the mean age was 62 years (SD = 11). Fifty-nine percent of patients reported poor sleep quality; 43% reported sleeping ≤6 h and 2% ≥10 h; 40% reported sleep latency of 30 min or greater; average sleep efficiency was 80%. Of the 292 patients, 58% reported clinically levels of depression and depressive symptoms were related to shorter sleep duration (p = 0.02). After adjusting for factors known to contribute to survival, a curvilinear relationship was observed between sleep duration and mortality: short and long sleep duration were associated with increased mortality [linear term: hazard ratio (HR) = 0.485, 95% confidence interval (CI) = 0.275-0.857; quadratic term: HR = 1.064, 95% CI = 1.015-1.115]. CONCLUSIONS: Consistent with findings in the general population, a curvilinear relationship between sleep duration and mortality was observed in advanced cancer patients. The high prevalence of sleep problems and link with mortality warrants routine screening and development of evidence-based treatments for sleep problems in the oncology setting.
OBJECTIVE: Sleep problems have been linked to increased risk of mortality in the general population. Limited evidence suggests similar relationships among people diagnosed with cancer. The aims of the present study were to investigate the type and rates of sleep problems in advanced cancerpatients and examine whether sleep problems are associated with survival. METHODS: A prospective study of 292 patients with advanced cancers affecting the hepatobiliary and pancreatic systems were administered a battery of questionnaires measuring sociodemographic information, sleep, and depression. Descriptive statistics, ANOVA, Chi-square, Kaplan-Meier survival, and Cox regression analyses were performed to test the aims. RESULTS: The majority of patients were male (64%) and the mean age was 62 years (SD = 11). Fifty-nine percent of patients reported poor sleep quality; 43% reported sleeping ≤6 h and 2% ≥10 h; 40% reported sleep latency of 30 min or greater; average sleep efficiency was 80%. Of the 292 patients, 58% reported clinically levels of depression and depressive symptoms were related to shorter sleep duration (p = 0.02). After adjusting for factors known to contribute to survival, a curvilinear relationship was observed between sleep duration and mortality: short and long sleep duration were associated with increased mortality [linear term: hazard ratio (HR) = 0.485, 95% confidence interval (CI) = 0.275-0.857; quadratic term: HR = 1.064, 95% CI = 1.015-1.115]. CONCLUSIONS: Consistent with findings in the general population, a curvilinear relationship between sleep duration and mortality was observed in advanced cancerpatients. The high prevalence of sleep problems and link with mortality warrants routine screening and development of evidence-based treatments for sleep problems in the oncology setting.
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